Computer Network Successfully Initiated
Hospital administrators and
electronics specialists from the IBM
Corporation are breathing a little
easier after deciding this week's
long-planned conversion from one
computer network to another was "a
complete success."
The new network, which has been
named the Duke Hospital
Information System (DHIS),
electronically links patient care units,
major service departments and
administrative areas so th'at patient
information can be routed
throughout the hospital almost
instantaneously.
It is replacing the Bur-
roughs/Medi-Data computer system
which has been discontinued after
four years of service, according to
Robert G. Winfree, acting assistant
vice president for health affairs
(planning and analysis).
Jointly Designed
DHIS was jointly designed and
developed over the past year by the
staff of the hospital and IBM.
“It provides the hospital with a
strong foundation for future
development, including applications
related to the outpatient clinics, the
operating room and resource
scheduling, to name but a few,"
Winfree said.
He also noted that the new system
is designed to serve the expanded
multiple hospital environment that
will exist when Duke Hospital North
is completed in 1979.
Medical Center Network
The network consists of 130
display terminals and 70 printers
located throughout the hospital. Bell
Building, the Eye Center and several
buildings in the Research Park
complex. The patient care units at the
Durham Rehabilitation Center and
the Drake Pavilion will be added to
the system in the near future.
The successful conversion to the
new information system reflects
what Mrs. Ruby Borden, R.N., called
"tremendous cooperation and team
spirit of the Duke staff." Mrs. Borden
is acting director of the DHIS office.
"Many people throughout the
institution devoted long hours to
designing and building the system,"
she said. "It could not have been
done without their strong support
and assistance."
Faster, More Accurate
Deloris Evans, data terminal
operator on the OB-GYN unit, noted
that DHIS is a significant
improvement. "The new system is
faster, more accurate and requires far
less typing because of the light
pen/menu selection process," she
said.
Winfree said that IBM's support
throughout the project has been a
key factor in developing the system.
"IBM has shown a total corporate
commitment to Duke, and the IBM
staff members assigned to the project
have been great," he added.
In 1972, Duke became the second
hospital in the country to adopt the
confplete Burroughs/Medi-Data
system. Wii\free said that Duke's
experience with Medi-Data was
important in designing DHIS.
"Over the past four years, we've
learned what a computerized
information system can — and
should — do to enhance patient care
and financial management
operations in a large and complex
environment," he said.
Intercom
Duke University Medical Center
VOLUME 23, NUMBER 40
OCTOBER 8,1976
DURHAM, NORTH CAROLINA
Child Given Sight as Rare Disease Treated
By David Williamson
A Jones County, N.C., child who
holds the dubious distinction of
being the world's fifth reported case
of a metabolic disease known as
tyrosinemia type II, has been
diagnosed and successfully treated
by Duke physicians.
The case is unusual, according to
Dr. Lowell A. Goldsmith, because
the girl is the first person of
Ango-Saxon ancestry to be found
with the condition. At least two of
the four earlier patients can trace
their roots back to remote villages in
Italy's Apennine Mountains.
Rare Condition
"This is such a rare condition that I
never thought I'd see another patient
with it," said Goldsmith, an
associate professor of dermatology.
"I thought it was a once-in-a-lifetime
kind of thing for me."
KttPISC THt TRAFFIC FLOWING—^Tratfic to the mam hospital entrance is now being
effectively limited to vehicles transporting patients and some commercial vehicles.
The access gate went into operation on Sept. 28, when the information booth was
staffed by Debbie Fletcher, pictured above. Ms. Fletcher said it was somewhat hectic
the first day, but now people are used to the new system and it is going smoothly. A
Durham native, Ms. Fletcher served 14 mos. in the U.S. Air Force and is now a
member of the Air National Guard. She anticipates a career in law enforcement.
(Photo by John Becton)
DR. LOWELL A. GOLDSMITH
The physician said he saw his first
case of tyrosinemia type II, which
can cause blindness, mental
retardation, and severe sores on the
hands and Teet of its victims, five
years ago at Massachusetts General
Hospital in Boston.
There he and his colleagues at the
Harvard Medical School were able to
discover the cause of the disease and
outline an effective treatment for it,
but they found no permanent cure,
he said.
The Jones County child, like her
predecessors in Boston and in more
recent medical literature, was found
to have very high levels of an amino
acid called tyrosine in her blood and
in her urine. Amino acids, which
serve as building blocks for proteins,
are organic compounds essential for
human metabolism.
Lacks Essential Enzyme
Her tyrosine level was 22 times
normal. Goldsmith said, because she
lacks an essential enzyme the liver
produces to convert the amino acid
into components of skin
pigmentation, thyroid hormones,
adrenalin and several other
ntetabolic products.
The child's tyrosine had risen to
such high levels that it began to
crystallize, he explained, and the
corneas of her eyes and the outer
layer of skin on her hands and feet
started breaking down.
Until she was admitted to the
Rankin Ward Clinical Research Unit,
the then 15-month-old girl was blind
and had the characteristic sores on
her hands and feet. In addition, she
was threatened with mental
retardation.
Low Tyrosine Diet
On the research ward, which is
supported by the National Institutes
of Health, the child received free
medical care and was placed on a low
tyrosine diet to reduce the level of
the chemical in her body.
Drs. John Reed, associate professor
of ophthalmology, and James
Sidbury, professor of pediatric
metabolism, both worked on the case
with Goldsmith.
"Within three days, the httle girl's
skin condition was improving and
her eyes were clearing," the
dermatologist said. "After 28 weeks
of treatment, she was growing and
actively playing, walking and
running.
"She had normal vision, and her
skin was perfectly normal," he said,
adding that while it is still too early
to rule out any retardation, her
mental development also seems
normal for her age.
Cause of Illness
What caused the child, who the
physicians are continuing to watch
and who may have to remain on the
special diet all her life, to become ill
in the first place? Goldsmith
explained it this way:
"Many of these kinds of diseases
occur when both parents contribute
an abnormal recessive gene to their
child. That's most common when the
parents have some sort of close blood
relationship.
"Although we haven't been able to
determine the exact degree of blood
relationship in this case, the fact that
the families of both parents have
lived in the same area of rural North
Carolina for more than 200 years and
have intermarried increases the
chance of a genetic disease like this
one," he said.
Goldsmith said marriages between
related villagers in the Italian
mountains accounted for the
occurrence of tryosinemia type II
there.